The Social Determinants of Mental Health

Ninety percent of the determinants of our health derive from our lifetime social and physical environment. By understanding and responding to these determinants of health, we can achieve better health and mental health. Professor Paula Lantz and her colleagues (1) put it well when they remarked that Americans are prone to “medicalize health and illness”—in fact, to confound health care with health. It is our behaviors and our habits (such as excessive and poor eating, excessive drinking and drug use, smoking, physical inactivity, and high intake of salt and processed food) that drive the lion's share (40%) of our ill health and early demise. In addition, we cannot dismiss the fact that an estimated 30% of our health is attributable to our genes, because we now understand (through the science of epigenetics) that genes are turned on or off by their exposure to our environment and what we do and do not do (2). In other words, behaviors and environment are the primary factors that we will need to change in order to avoid or delay disease and achieve better health.

As we become more aware of the factors contributing to health, including mental health, public health officials in both developing and developed countries are also increasingly aware that noncommunicable diseases (NCDs) have surpassed communicable diseases in global morbidity and mortality. Conditions such as cardiovascular disease, pulmonary disorders (including asthma and obstructive lung diseases), neurological conditions (such as Alzheimer’s, Parkinson’s, and stroke), and highly prevalent and disabling mental disorders (such as depression; anxiety disorders, including posttraumatic stress disorder; substance use disorders; and psychotic illnesses) affect more than 1 billion individuals worldwide. NCDs account for two-thirds of the deaths each year on this planet (3). No longer do infectious diseases, such as plague, cholera, tuberculosis, and more recently HIV/AIDS, occupy center stage in the world’s health. Moreover, mental and addictive disorders frequently co-occur with chronic general medical illnesses, substantially impairing prevention, worsening the course of these illnesses, and increasing suffering and social burden (4).

We need to look beyond traditional hospital and medical practice venues to improve health and longevity and to control the massive costs that accrue from the consequences of poor health, including disability, work absenteeism and reduced productivity, and often unnecessary and certainly expensive medical and pharmaceutical treatments (5).